Attention! New ACT Social Skills Groups
are Beginning Soon!
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An ACT Social Skills
Group is a great place for your child to practice
his or her social skills! Fun, exciting and
creative group activities are led by expereinced ACT
therapists and supervisors. Please contact the
front office for more
information!
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Dear ACT readers,
ACT welcomes you to another issue of the
ACT Newsletter! In this Fall Issue we are
presenting an article that describes behavior
techniques that successfully decreases medical
exam fears in children on the autism
spectrum. Additionally, we are offering you
another tool for your behaivor toolbox: 10
Tips for Decreasing Perseveration on Preferred
Topics During Conversation. We are also
going to introduce you to another fun kid,
Lucas!
Also, check out the link to the
Helping Hands Family Behavior
Support Group. This is a
new service offered by ACT that provides behavior
management consultation and support to parents
whose children are otherwise typically developing
but have behavioral challenges. You never
know who might need a Helping
Hand.
We hope you enjoy this issue of the ACT
Newsletter!
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10 Tips for Decreasing
Perseveration on Preferred Topics During
Conversation
 Good conversation
skills are essential for meaningful social
interaction. Children with High Functioning
Autism (HFA) and Asperger's Syndrome (AS) have a
unique set of challenges in the areas of social
communication and conversation with peers.
This article will give you specific tips for
developing your child's conversation skills.
For children with HFA and AS, the main challenges
during conversations include being able to talk
about a large variety of topics, focusing on
peers' ideas, restricting the amount of time spent
talking about themselves and their preferred
topics, and being able to read the body language
of their conversation
partners.
Most children with HFA and AS
have topics or areas of interest about which they
are extremely knowledgeable. A child may be
interested in topics like vacuums, stamps, or
pens. These are interests that are less
likely to be shared by peers. Even when a
child's interest is more common (e.g., dinosaurs,
trains, or sports), he or she will learn more
about the topic than most peers. It is
important to help your child have conversations
about a wider variety of topics so he or she will
feel confident with peers and be included in
social interactions. You can practice these
skills by having daily conversations with your
child about a variety of topics.
Below are 10 simple tips for
expanding your child's conversation skills.
Tip #1 - Start with topics
that are similar to your child's preferred topic,
and gradually make the topics more
varied. For
example, if your child's preferred topic is Star
Wars, you can begin by having conversations about
planets or astronauts.
Tip #2 - Reinforce
conversations about less preferred topics with fun
conversations about your child's favorite
topic. For example,
discuss Halloween for 2 minutes, then the Roman
Empire for 3 minutes. To start, the less
preferred conversation should be shorter, and the
preferred one longer. Over time, the less
preferred conversation can be increased and the
preferred conversation decreased.
Tip #3 - Make discussing less
preferred topics more interesting by allowing your
child to pick a topic from another area of
interest or a choice of
three. Or - you,
your child, and a sibling/peer can each write down
5 fun or interesting ideas, throw them into a box
or hat, and take turns choosing topics to talk
about from there. That way your child's
preferred topics will be naturally mixed in with
his less preferred topics, and he will understand
that other people have different areas of
interest.
Tip #4 - Give your child a
clear and measurable "rule" for
conversations. For
example, "Say one thing about yourself, then ask
your friend a question about herself," or, "Wait
until your friend has said three things about his
topic, then you can change the subject."
Practice these skills daily in conversations
with your child, and remind your child of the
rules before she interacts with peers.
Remember not to set too many rules; you don't want
to overwhelm your child. Instead, set one
rule, let your child master that rule, and then
add another rule to the mix.
Tip #5 - Restrict the amount
of time your child can engage in preferred
conversations. For
example, allow conversation about a preferred
topic only twice per day for five minutes each
time. Be sure to engage in those
conversations with gusto when it's time for
them! At other times, remind your child of
this guideline and encourage conversations about
other interesting topics. Don't forget to
reinforce your child for remembering and
trying!
Tip #6 - If your child is
"bursting" to talk about a preferred topic, and
you want to limit how frequently he discusses that
topic, give your child a specific time when the
topic can be discussed (e.g., "We aren't going to
talk about dinosaurs right now, but we can during
lunch time"). It also
works to have your child journal (write things
down) when he is "dying" to share something and
it's not the right time.
Tip #7 - Make a chart of
different types of body language and their
translation, review it with your child, and give
it to your child to keep or post somewhere
discreet. This will allow
your child to consult it at a later date if
necessary. For example, looking away = not
interested; smiling = interested. Be sure to
demonstrate different types of body language for
your child during conversations, and discuss what
each gesture and facial expression means.
For example, you can nod while your child is
talking, and explain that this means that you're
interested in the conversation. Yawning may
mean that the listener is bored, looking at a
watch may mean that the listener is in a hurry,
and crossed arms might mean that the listener is
upset. Observe your family and friends for a day
or two to come up with a comprehensive list of
things to teach, or check out the internet for
suggestions.
Tip #8 - Practice what to do
in social situations when peers might be losing
interest or want to change the
subject. For example, if a
friend is looking down, teach your child to ask,
"What do you want to talk about?"
Tip #9 - Have your child pick
a favorite friend from school and list a few
things she knows about that friend; use the list
to brainstorm about topics that the friend might
enjoy discussing.
Prepare your child to ask questions or make
comments to her friend based on the things she
thinks her friend might like to talk about.
This will help expand your child's "theory of
mind" - her understanding of other people's
thoughts and preferences.
Tip #10 - Prepare your child
to join and leave conversations involving a group
of peers. Write down the 4
or 5 steps involved in starting, joining, and
ending conversations and changing the
subject. For example, the steps involved in
joining a conversation are:
1. Listen to
the topic being discussed.
2.
Think of something related to say or
ask.
3. Wait for a pause in
the conversation.
4. Make
your statement or ask your
question.
5. Look at the
person who responds, listen to
what she
says, and respond to her.
If you use these tips and
practice conversation skills daily, your child
will be able to talk about a wider variety of
topics, focus on her peers' ideas, restrict
discussing highly preferred but repetitive topics,
and understand body language
better.
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Fear of
Routine Medical Exams in Children with Autism
Spectrum
Disorders
(Gillis, Natof, Lockshin &
Romanczyk, 2009)
As many parents may have
experienced, children with Autism can have a very
difficult time with medical examinations. It
can be a significant source of frustration for
both parents and children. This article
describes two studies. The first is an
assessment of the prevalence of medical
examination fears among children with Autism
Spectrum Disorders. The second is an
evaluation of a behavioral intervention (graduated
in vivo exposure and reinforced practice) designed
to reduce a child's fear of medical
visits.
Research demonstrates that
anxiety disorders occur often in children with
Autism. Researchers have examined fears
related to the environment and procedures
associated with medical exams in typically
developing children; however, studies
investigating fears in children with Autism have
not looked specifically at medical exams.
Authors Knapp, Barrett, Groden, and Groden (1992)
reported that there are many similarities between
the types of fears seen in typical children and
those with Autism. A fear of medical exams
is one of these standard fears.
The first study in this article
examines the specific types of fears that children
with Autism have in relation to medical
exams. The study found that most parents
reported that medical visits were significantly
challenging, and that most children were upset by
having their ears and throats examined and blood
drawn. Fewer children were upset by having
their hearts and breathing examined with a
stethoscope, or by the use of a knee reflex
hammer.
The authors argue that finding
ways to decrease specific fears of medical exams
in children with Autism is extremely
important. A large portion of children in
this study attend medical visits 2 to 3 times per
year. One third of the children have a
chronic medical condition that warrants frequent
medical visits. If a child refuses to let
the doctor perform necessary procedures, it can
make health conditions worse and harm the
child.
The second study in this article
examined behavioral treatments that can help
reduce a child's fear of medical exams. This
study included 18 children who attended a special
school for children with Autism Spectrum
Disorders. The goal of the study was to
implement specific behavioral strategies with
these 18 children and determine if the strategies
decreased the children's fear of medical
exams.
Evaluation took place in the
school nurse's office. All of the children
were initially given a brief physical exam to
determine how they typically reacted to medical
examination, and establish baseline data.
During the initial physical exam, the children's
observable behaviors (e.g., refusal to enter the
nurse's office, pushing medical instruments away,
crying, and running away) were used to measure
each child's level of fear. Throughout the
baseline exams, the authors noted which parts of
the exam each child feared the most. A
hierarchy of fears was created for every
child.
After baseline behavior was
established, the intervention phase began.
During the intervention phase, the children were
exposed to the parts of the medical exam that they
feared according to their hierarchy. The
steps were introduced in the order that they would
naturally occur during the medical exam. For
example, if a child walked to the nurse's office
without anxiety, but feared the stethoscope,
tolerating the stethoscope would be the first step
addressed for that child. This child would
not participate in the remainder of the exam until
he could tolerate the stethoscope without
anxiety.
During each treatment session,
each child's behavior was rated. A score of
0 was neutral, scores of +1, +2, and +3 were
positive, and scores of -1, -2, and -3 were
negative (indicating anxiety). When a child
received a neutral or positive score for a
particular step, he was given a preferred toy as
reinforcement for having participated in that step
without anxiety. When a child received a
neutral or positive score on two consecutive
sessions, that step was considered mastered, and
the child moved on to the next step in the fear
hierarchy. Treatment was continued until
most children could sit through an entire exam
without anxiety. A follow up exam was
conducted several months later to see if the
children had maintained their tolerance of medical
exams.
Results indicated that after 25
treatment sessions, 15 of the 18 children were
able to tolerate the medical exam across two
consecutive weeks with no anxiety.
Intervention continued for the remaining 3
children for 62 sessions. These 3 children
made progress, but ended up not completing all of
the steps. Results indicated that there was
a correlation between how many steps were feared
at the beginning of treatment and how many
sessions it took to complete all of the steps
successfully. In other words, children who
feared fewer steps took fewer sessions to complete
the steps successfully, and vice versa. The
3 children who did not complete all of the steps
in the fear hierarchy had significantly more fears
than the children who did complete all of the
steps. The authors note that these 3
children would likely have been able to complete
all of the steps at some point. During
follow-up, 14 of the original 18 children were
assessed. Ten out of the 14 demonstrated no
fear of the medical exam. The remaining 4
children showed fear for only one specific
instrument or procedure. The authors comment
that the results suggest that graduated in vivo
exposure and reinforced practice are useful tools
for reducing fear of medical exams. They
also note that more studies should be conducted to
confirm their findings, and dental exam fears
should be studied, as well.
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Lucas'
Story
ACT would like to introduce its
readers to another very cool kid. Lucas is a
bright 11 year old boy who loves dinosaurs,
Pokeman, riding his scooter, and downloading
"apps" for his iphone. His mother describes
him as enthusiastic, "prehistoric", and
adorable. Today, Lucas is a happy and unique
fifth grader who has a thirst for knowledge and is
learning many new skills. However, when
Lucas was two years old, his mother recalls that
he had almost no language. She was concerned
that he wasn't talking and brought this to the
attention of his pediatrician. At the time,
the doctor insisted that Lucas would eventually
begin to talk and recommended speech therapy for
him.
Lucas began speech therapy at two
years of age and continued until he was six.
His language skills slowly improved across those
four years. Lucas' mother was concerned
about other behaviors, as well. Lucas had
meltdowns when he didn't get something he wanted
right away. He had difficulty expressing
frustration and anxiety, and having tantrums was
his way of communicating those feelings.
Lucas' mother reports that it would take a long
time to calm him down once he became upset.
He was also a picky eater, eating only 3 or 4
preferred foods.
At school, Lucas had a very
difficult time making friends and navigating social situations.
Academically, Lucas appeared to be above average
in many areas; however, he had trouble with
reading. Despite his difficulty with
reading, Lucas was able to learn tremendous
amounts of information about his most preferred
subjects - dinosaurs and prehistoric times.
Lucas' mother recalls wondering
throughout the years if he had Autism or
Asperger's Syndrome. She points out that
Lucas has always been a very affectionate and
loving child, who seemed to want to have friends
and be social. This aspect of his
personality was contradictory to what she had
heard about children with Autism Spectrum
Disorders (ASDs). Lucas was finally assessed
by a psychologist who was familiar with
ASDs. He was diagnosed with High Functioning
Autism when he was in the third grade.
Shortly after his diagnosis,
Lucas began to have behavior therapy with
ACT. Throughout the past two years Lucas has
been learning many new skills in therapy.
Socially, he is learning how to "read" other
people's body language, have conversations about a
wider variety of topics, use his own body language
to show others what he is feeling, and understand
complex socials situations. He is also
learning how to identify anxiety and frustration,
express these feelings appropriately, and use
self-management tools to calm himself down.
Lucas is being taught to better manage his time,
plan and organize activities, and practice
effective study skills. He has also
participated in ACT social skills groups, where he
worked on generalizing skills he was learning in
therapy and practicing social skills with his
peers.
Lucas' mother reports that he
rarely has meltdowns anymore. He is better
able to think rationally about situations and use
healthy coping techniques to calm himself
down. Because of the coping strategies, she
says that she sees a significant decrease in
Lucas' daily anxiety. She comments that his
social skills are improving, as well. She
and her husband are extremely proud of Lucas'
efforts and progress. Lucas will be starting
middle school next year, and his mother looks
forward to seeing how he will learn and grow
during his teenage
years! | |
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We hope that you have enjoyed this issue of
ACT's Newsletter and found it useful! Please
contact us if there are topics you would like to
see addressed in the newsletter in the
future. You may suggest topics by sending an
email to: Sarah.Pashalides@AutismCenterforTreatment.com
Look for our next issue in
Winter,
2010!
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